Cilostazol: an antiplatelet agent for the neurointerventionist?

Bhogal, Paul; Brouwer, Patrick A.; Makalanda, Hegoda Levansri Dilrukshan

doi:10.1136/neurintsurg-2014-011570

Cited by 8 publications

(8 citation statements)

References 21 publications

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“…Cilostazol, a potent PDE3 inhibitor, inhibits the platelet activation and aggregation pathway via increasing the intracellular level of cyclic adenosine monophosphate (Bhogal et al, 2016). In addition to its antiplatelet function, cilostazol can not only improve lipid metabolism and suppress the proliferation of arterial SMCs, but can also alleviate inflammatory reactions, improve vascular endothelial functions and dilate blood vessels (Zhang et al, 2015).…”

Section: Management and Treatmentmentioning

confidence: 99%

Intracranial atherosclerotic disease

Wang

Meng

Liu

et al. 2019

Neurobiology of Disease

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Intracranial atherosclerosis (ICAS) is a progressive pathological process that causes progressive stenosis and cerebral hypoperfusion and is a major cause of stroke occurrence and recurrence around the world. Multiple factors contribute to the development of ICAS. Angiography imaging techniques can improve the diagnosis of and the selection of appropriate treatment regimens for ICAS. Neither aggressive medication nor endovascular interventions can eradicate stroke recurrence in patients with ICAS. Non-pharmacological therapies such as remote ischemic conditioning and hypothermia are emerging. Comprehensive therapy with medication in combination with endovascular intervention and/or non-pharmacological treatment may be a potential strategy for ICAS treatment in the future. We summarized the epidemiology, pathophysiological mechanisms, risk factors, biomarkers, imaging and management of ICAS.

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Section: Management and Treatmentmentioning

confidence: 99%

Intracranial atherosclerotic disease

Wang

Meng

Liu

et al. 2019

Neurobiology of Disease

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“…Several clinical trials had shown that the addition of cilostazol to a regimen with another antiplatelet agent can decrease the recurrence of stroke without increasing the risk of bleeding 16,[18][19][20] . It is well known that, in addition to its antiplatelet effect, cilostazol has various effects such as vascular protection, antiproliferation, alleviation of ischemiareperfusion injury, and antiatherosclerosis 16,[21][22][23] . Therefore, the combination of traditional antiplatelet agents with cilostazol is a regimen that can be recommended for patients undergoing arterial stenting.…”

Section: Discussionmentioning

confidence: 99%

“…4A). There was no difference in gastrointestinal discomfort between the two groups (cilostazol group vs. clopidogrel group; antiplatelet effect, cilostazol also has vascular protection, antiproliferation, alleviation of ischemiareperfusion injury, and antiatherosclerosis effects 16,[21][22][23] , which may improve the prognosis of patients with stroke, especially after intracranial or extracranial arterial stenting. In addition, the antiplatelet effect of cilostazol is not inferior to aspirin or clopidogrel, and the risk of bleeding is lower.…”

Section: Safety Outcomesmentioning

confidence: 93%

Comparison of Cilostazol versus Clopidogrel in Addition to Aspirin in Patients with Ischemic Stroke who Underwent Intracranial or Extracranial Artery Stent Implantation

Liu

Shao

Yang

et al. 2023

JAT

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Aims:The role of cilostazol after intracranial or extracranial artery stent implantation is still unclear. Therefore, we designed this trial to explore the efficacy and safety of cilostazol in this particular population. Methods:In this retrospective study, patients were divided into the cilostazol or clopidogrel group by the antiplatelet therapy received after artery stent implantation. The primary efficacy endpoint was ischemic stroke. Bleeding events and other antiplatelet drug-related adverse reactions (ADRs) were also recorded. Neurological function prognosis was evaluated by the modified Rankin Scale (mRS) after discharge.Results: A total of 156 patients were enrolled; 56 underwent intracranial artery stenting, 95 underwent extracranial artery stenting, and 5 underwent intracranial combined with extracranial artery stenting. Any stroke and bleeding events in the hospital of the two groups were comparable (P=0.38, P=0.34, respectively). The incidence of stroke recurrence tended to be lower in the cilostazol group, although not significant (cilostazol vs. clopidogrel, 1.35% vs. 4.88%, P=0.25). There was a significant difference of any bleeding events between the two groups (cilostazol vs. clopidogrel, 5.41% vs. 20.73%, P=0.02). During follow-up, we did not observe an apparent increase of ADRs in the cilostazol group (cilostazol vs. clopidogrel, palpitation 4.05% vs. 2.44%, P=0.58; gastrointestinal discomfort events 8.11% vs. 12.20%, P=0.80). There were no differences between the two groups of neurological function prognosis (P=0.29). Conclusions:Cilostazol-based dual antiplatelet therapy could be recommended as an effective and safe therapy regimen among patients undergoing intracranial or extracranial artery stent implantation.

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“…The high stroke incidence worldwide and ineligibility of many patients to thrombolysis make aspirin a fundamental therapy for AIS (Alderazi and Grotta, 2014). Dual antiplatelet treatments of aspirin and drugs with different mechanisms such as cyclic nucleotide phosphodiesterase inhibitors (dipyridamole, cilostazol) and purinergic receptors P2Y antagonists (clopidogrel) are also safe and effective in reducing stroke recurrence (Geeganage et al, 2012;Bhogal et al, 2014).…”

Section: Antiplatelet Therapymentioning

confidence: 99%